Moving to a more restrictive transfusion protocol: Outcomes in head and neck free flap surgery

Skoog, Hunter; Chisolm, Paul F; Altonji, Samuel J.; Moore, Lindsay; Carroll, William R.; Richman, Joshua S.; Greene, Bruce M.; Grayson, Jessica W.

doi:10.1016/j.amjoto.2021.103268

Cited by 6 publications

(7 citation statements)

References 19 publications

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“…On one hand, a low hematocrit impairs oxygen delivery, thereby reducing flap perfusion and survival, 20,21 but fluid overload can increase the risk of venous congestion. Other studies have concluded that pRBC transfusions do not impact flap failure or take‐back rates 22,23 . The rate of transfusion in the current study (26.4%) is lower than previously reported studies.…”

Section: Discussioncontrasting

confidence: 73%

Effect of Perioperative Antithrombotics on Postoperative Transfusion and Hematoma in Head and Neck Free Flaps

Hicks,

Vasudev,

Bishop

et al. 2023

OTO Open

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ObjectiveTo explore if antiplatelet or anticoagulant therapy increases the risk of transfusion requirement or postoperative hematoma formation in patients undergoing microvascular reconstruction for head and neck defects.Study DesignRetrospective cohort study.SettingDepartments of Otolaryngology–Head and Neck Surgery at the University of Alabama at Birmingham, the University of Colorado, and the University of California Irvine.MethodsA multi‐institutional, retrospective review on microvascular reconstruction of the head and neck between August 2013 to July 2021. Perioperative antithrombotic data were collected to examine predictors of postoperative transfusion and hematoma.ResultsA total of 843 free flaps were performed. Preoperative hemoglobin, hematocrit, operative time, and flap type were positive predictors of postoperative transfusion in both bivariate (P < .0001) and multivariate analyses (P < .0001). However, neither anticoagulation nor antiplatelet therapy were predictive of postoperative transfusion rates and hematoma formation.ConclusionAntithrombotic regimens do not increase the risk of postoperative transfusion or hematoma in head and neck microvascular reconstruction. Based on this limited data, perioperative antithrombotic regimens can be considered in patients who may otherwise be at risk for these postoperative complications.

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Section: Discussioncontrasting

confidence: 73%

Effect of Perioperative Antithrombotics on Postoperative Transfusion and Hematoma in Head and Neck Free Flaps

Hicks,

Vasudev,

Bishop

et al. 2023

OTO Open

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“…Our blood transfusion rate was 15.08%, which is lower than the 18.07 to 58% reported in previous studies. 12,13,25 The two centers from which we collected data (the Affiliated Hospital of Southwest Medical University and Dental Hospital Affiliated to Zunyi Medical University) adopted a restrictive blood transfusion strategy. Doctors carefully considered blood transfusion according to the actual situation of patients and hemoglobin (Hgb < 7.0 g/dL).…”

Section: Discussionmentioning

confidence: 99%

“…Some studies believe that PBT are associated with flap complications, 4,[8][9][10] whereas others emphasize that PBT does not affect flap complications. [11][12][13] In addition to the small sample size and commonly evaluated single-center outcomes, these studies are often not limited to the head and neck, so the research results need to be further demonstrated. In this study, we used propensity score matching (PSM) to control the confounding factors of PBT and evaluated the impact of PBT on flap complications and medical complications in patients undergoing oral free-flap reconstruction.…”

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confidence: 99%

Effect of Perioperative Blood Transfusion on Postoperative Complications of Free-Flap Reconstruction for Oral Cancer: Analysis of Propensity Score-Matched Cohorts

Chen,

Lei,

et al. 2024

J Reconstr Microsurg Open

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Background It has been confirmed in other fields that perioperative blood transfusion (PBT) will increase the incidence of complications after free-flap reconstruction and increase the risk of patients returning to the operating room within 48 hours after the initial operation. However, for head and neck tumors, whether PBT is related to postoperative complications is debatable. The aim of this study was to control the demographic and comorbidity characteristics of patients by propensity score matching (PSM) as well as to investigate the relationship between PBT and postoperative complications after oral cancer free-flap reconstruction. Methods A total of 597 patients who underwent microvascular free tissue transfer in two top three hospitals in Southwest China from January 2015 to July 2023 were retrospectively reviewed. The study population was divided based on PBT within 24 hours of the start of the operation and to ensure homogeneity between groups by using the PSM. The primary outcomes were postoperative complications; secondary outcomes were to explore the intraoperative risk factors of PBT. Results A total of 597 patients were included. Among them, 90 patients received a PBT. Those patients were successfully matched with 86 similar patients who did not receive a transfusion on a ratio of 1:1. This study did not find that patients receive a transfusion had a significantly higher risk of vascular pedicle thrombosis (p = 1.000), hematoma (p = 1.000), flap failure (p = 0.398), flap-related complications (p = 0.470), and other medical complications (p = 1.000). After controlling the preoperative confounding factors and adjusting the logistic regression model, it was concluded that the tumor location-mandible (odds ratio [OR] = 19.923, 95% confidence interval [CI]: 1.213–327.302, p = 0.036) and operation time (OR = 1.011, 95% CI: 1.008–1.014, p < 0.001) were the intraoperative risk factors for PBT. Conclusion PBT is not associated with an increased probability of postoperative complications. Mandibular tumor may have a higher risk of PBT.

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“…The sequelae of PBT are associated with the volume of blood transfused; the use of 3 units or more is associated with poorer recurrence-free survival and overall survival [ 11 ]. Conversely, timing of PBT is not associated with some outcomes, such as flap outcomes [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Preoperative hemoglobin and perioperative blood transfusion in major head and neck surgery: A systematic review and meta-analysis

Ali

Dort

Sauro

2023

Journal of Otolaryngology - Head & Neck Surgery

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Background There is a growing concern with inappropriate, excessive perioperative blood transfusions. Understanding the influence of low preoperative hemoglobin (Hgb) on perioperative blood transfusion (PBT) in head and neck cancer (HNC) surgery with free flap reconstruction may help guide clinical practice to reduce inappropriate treatment among these patients. The objective is to synthesize evidence regarding the association between preoperative Hgb and PBT among major HNC free flap surgeries. Methods Terms and synonyms for HNC surgical procedures, Hgb and PBT were used to search MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials and Cochrane Database of Reviews from inception to February 2020. Reference lists of included full texts and studies reporting the preoperative Hgb, anemia or hematocrit (exposure) and the PBT (outcome) in major HNC surgery with free flap reconstruction were eligible. Studies examining esophageal, thyroid and parathyroid neoplasms were excluded; as were case reports, case series (n < 20), editorials, reviews, perspectives, viewpoints and responses. Two independent, blinded reviewers screened titles, abstracts and full texts in duplicate. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was followed. A random-effects model was used to pool reported data. The primary outcome was the proportion of patients who had a PBT. Subgroup analysis examined sources of heterogeneity for perioperative predictors of PBT (age, sex, flap type, flap site and preoperative Hgb). We also examined mean preoperative Hgb in the PBT and no PBT groups. Results Patients with low preoperative Hgb were transfused more than those with normal Hgb (47.62%, 95% CI = 41.19–54.06, I2 = 0.00% and 13.92%, 95% CI = 10.19–17.65, I2 = 20.69%, respectively). None of the predictor variables explained PBT. The overall pooled mean preoperative Hgb was 12.96 g/dL (95% CI = 11.33–14.59, I2 = 0.00%) and was 13.58 g/dL (95% CI = 11.95–15.21, I2 = 0.00%) in the no PBT group and 12.05 g/dL (95% CI = 10.01 to 14.09, I2 = 0.00%) in the PBT group. Conclusions The heterogeneity between studies, especially around the trigger for PBT, highlights the need for additional research to guide clinical practice of preoperative Hgb related to PBT to enhance patient outcomes and improve healthcare stewardship. Graphical abstract

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Moving to a more restrictive transfusion protocol: Outcomes in head and neck free flap surgery

Cited by 6 publications

References 19 publications

Effect of Perioperative Antithrombotics on Postoperative Transfusion and Hematoma in Head and Neck Free Flaps

Effect of Perioperative Antithrombotics on Postoperative Transfusion and Hematoma in Head and Neck Free Flaps

Effect of Perioperative Blood Transfusion on Postoperative Complications of Free-Flap Reconstruction for Oral Cancer: Analysis of Propensity Score-Matched Cohorts

Preoperative hemoglobin and perioperative blood transfusion in major head and neck surgery: A systematic review and meta-analysis

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